Basic Information
| Provider Information | |||||||||
| NPI: | 1881770998 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BELOIT HEALTH SYSTEM INC | ||||||||
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| OtherOrganizationName: | BELOIT MEMORIAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1969 W HART RD | ||||||||
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| City: | BELOIT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535112230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083645011 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1969 W HART RD | ||||||||
| Address2: | |||||||||
| City: | BELOIT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535112230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083645011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 09/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | BUA | ||||||||
| AuthorizedOfficialFirstName: | MICHEAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR, FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 6083645377 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 09/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2472R0900X | 67 | WI | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Technician, Other | Renal Dialysis |
No ID Information.